Abstract

In a survey of 1794 UK NHS hospital consultants 1308 (73%) responded.
Psychiatric morbidity (General Health Questionnaire–12 score ≥4) was
present in 32% of responders, who were twice as likely to report drinking
hazardous levels of alcohol, being irritable with patients and colleagues,
reducing their standards of care and intending to retire early (all P < 0.001). Male and mid-aged consultants were also particularly at risk.
Approaches that support consultants to practice medicine safely throughout
their careers are required.

Up to a third of hospital consultants are estimated to experience
psychiatric morbidity at any one time
(Graham & Ramirez, 1997;
Taylor et al, 2005).
Poor mental health is clearly detrimental to doctors' lives, but less is known
about the extent of its impact upon patient care. Harmful alcohol consumption,
impaired clinical performance and planned early retirement detract from
patient care. We have estimated the prevalence of these behaviours, identified
demographic risk factors and explored the relationship between these
behaviours and poor mental health.

METHOD

A confidential postal survey was sent to 1794 UK NHS hospital consultants
in late 2002. The sample included all surgical oncologists, medical
oncologists and clinical oncologists, a random sample of gastroenterologists
(two in three) and a random sample of radiologists (one in five). Consultants
were ascertained through the UK medical Royal Colleges and professional bodies
to which they were affiliated. Sampling and ascertainment are described in
detail elsewhere (Taylor et al,
2005). Psychiatric morbidity was estimated using the General
Health Questionnaire–12 (GHQ–12;
Goldberg & Williams, 1988).
Harmful alcohol consumption was screened using the World Health Organization's
Alcohol Use Disorders Identification Test (AUDIT;
Saunders et al, 1993).
Impaired clinical performance was measured using a scale adapted from
Firth-Cozens et al (1997), whereby the frequency that stress at work
had caused irritability with colleagues, irritability with patients and
reduction in standards of care (such as taking short cuts) was rated on
four-point scale from `never to my knowledge' to `at least weekly'. Early
retirement was defined as intending to retire aged ≤55 years. Demographic
measures included gender, age and marital status. Hierarchical logistic
regression models were developed. Each univariately significant demographic
variable was entered into a multivariate model (model 1) followed by the
additional impact, if any, of poor mental health (GHQ score ≥4; model 2).
Analysis of relationships with planned early retirement necessarily excluded
consultants aged over 55. Individuals with missing data were excluded on a
test-by-test basis. Missing data constituted less than 5% except AUDIT scores
(9%) and intended retirement age (7%). All tests were two-tailed, using a 5%
significance level, and all analysis was conducted using SPSS v.12.0.1 for
Windows.

RESULTS

Questionnaires were returned by 1308 consultants (73%), of whom 19% (251)
were women, 89% (1151) were married or cohabiting, 4% (52) were aged < 35
years, 41% (534) were aged 36–45, 36% (473) were aged 46–55 and
19% (242) aged > 55 years (Table DS1 in the data supplement to the online
version of this paper).

In all, 32% of consultants (414) were estimated to have psychiatric
morbidity (Table DS1 in the data supplement); 17% of consultants (207)
reported consuming hazardous quantities of alcohol; 33% (432) reported that,
at least monthly in the last 6 months, stress at work had caused them to be
irritable with colleagues; 16% (212) reported being irritable with patients;
17% (221) had reduced their standards of care through, for example, taking
short cuts or not following procedures; and 18% (176) planned to retire
early.

Male consultants were more likely to report harmful consumption of alcohol;
consultants aged between 36 and 45 years (mid-aged) and those who were
unmarried were more likely to report being irritable with colleagues; younger
consultants were more likely to report being irritable with patients; male
consultants and mid-aged consultants were more likely to report reducing their
standards of care; and female consultants and mid-aged consultants were more
likely to intend to retire early (Table
1: model 1). Poor mental health independently increased
consultants' likelihood of reporting all of these behaviours
(Table 1: model 2).

Predictors of harmful alcohol use (score ≥8 for men, ≥7 for women on
the Alcohol Use Disorders Identification Test), impaired performance at work
(being irritable with colleagues or with patients, or reducing standards of
care, at least monthly in the past 6 months) and intention to retire early
(aged ≤55 years): logistic regression

DISCUSSION

These findings suggest that hospital consultants with poor mental health
are substantially more likely to report harmful consumption of alcohol, being
irritable with patients, being irritable with colleagues, reducing their
standards of care at work and/or planning to retire early. In addition, we
have shown that male and mid-aged consultants are particularly at risk.

Our study included a large national cohort of consultants from five
specialties. Despite the sensitive nature of the survey questions, the
response rate was high, giving us confidence that the sample is
representative. The cross-sectional design limits interpretation of causality,
and assessments of mental health and consultant behaviours relied upon
self-report measures. However, both the GHQ–12 and the AUDIT have been
shown to be reliable and valid screening tools.

To our knowledge, this is the first study to examine the relationship
between the mental health of hospital consultants and behaviours that detract
from patient care.

Our finding that male consultants were more at risk of harmful alcohol
consumption is consistent with findings from general population surveys.
Perhaps more surprising is the increased risk of impaired clinical performance
and planned early retirement at mid-age. Consultants appear to be particularly
vulnerable at this phase in their career (e.g.
Spickard et al, 2002),
which may be due to the fact that the honeymoon period of achieving consultant
status is over but retirement is far from sight. They will have accumulated
all of the responsibility and associated pressures, and are also more likely
to have high demands on their time from home, with many having young
families.

This study adds to the growing literature which highlights the critical
importance to patients, as well as to doctors, of identifying approaches that
protect consultants' mental health and support them to practice medicine
safely throughout their careers.

Acknowledgments

We thank the consultants who took part in the survey, Royal Colleges of
Physicians and Radiologists, British Society for Gastroenterology and British
Association of Surgical Oncologists for their support.

This study was jointly funded by the Charitable Foundation of Guy's and St
Thomas' Hospitals (London, UK) and Cancer Research UK.